Path IV Flashcards
characteristics of autoimmune gastritis
Ab to parietal cells and IF that can be detected in serum and gastric secretions
Pathogenesis autoimmune gastritis
CD4 T cells against parietal cell components like H/K ATPase
chief cells get destroyed too
reduced serum pepsinogen
antral/fundic hyperplasia
Vit B12 def
defective gastric acid secretion (achlorhydria)
autoimmune gastritis is assoc with what
increased risk gastric cancer and carcinoid tumros
assoc with hashimoto thyroiditis, graves, type I DM, addison, myasthenia gravis, vitiligo
how to differentiat H pylor assoc chronic gastritis or autoimmune
HP antrum / AI is in body of stomach!!!!
HP neutrophils plasma cells/ AI lymphocytes and macrophages
HP acid increased / AI acid decreased
HP gastrin norm or dec / AI gastrin increased
HP hyperplastic inflammatory polyps / AI neuroendocrine hyperplasia!!!
sequelae of H pylor assoc gastritis
peptic ulcer, adenocarcinoma, MALT lymphoma
sequelae autoimmune gastritis
atrophy, pernicious anemia, adenocarcinoma, carcinoid tumor
uncommon forms of gastritis
reactive gastropathy
esosinphilic gastritis
lymphocytic gastritis- celiac
granulomatous gastritis
causes of granulomatous gastritis
crohn disease, mycobacteria, fungi, CMV and H pylori
What are peptic ulcers
chronic, usually solitary lesions that occur in any part of GI tract exposed to aggressive acid/peptide juices
go through muscularis mucosae
where are most peptic ulcers
duodenum 4: 1 stomach
peptic ulcers are more common in male or femal
male
complicaitons of peptic ulcers
bleeding, perforation, obstruction
what do cancerous ulcers look like
have elevated margins
what will CXR show if have gastric perforation
free air under diaphragm
Tx for peptic ulcers
Antibiotics for H pylori
PPI
remove offending agent (NSAID)
surgery if massive bleed/perforated (antrectomy, vagotomy)
what is melena and what causes it
dark tarry stools
digestive enzymes act on blood and change its color
what is hematochezia and what causes it
usually GI bleed in colon because still bright red
what does it mean if blood appears like coffee grounds coming out of NG tube
slow bleeding or oozing
red blood and clots from NG tubes means what
active ongoing bleed
bile stained aspirate from NG tube
no active bleeding above treitz ligament
does clear NG aspirate meand there is no bleeding anywhere
no because GI bleed can be intermittant
procedure of choice to confirm bleeding site
upper GI endoscopy
what can be used to stop upper GI bleed
injection therapy with epinephrine or electro coagulation techniques
diseases that cause hypertrophic gastritis
menetrier and zollinger ellison
gross structure of hypertrophic gastropathy
thickened cerebriform gastric folds
two important points of hypertrophic gastropathy
may mimic carcinoma or lymphoma
could have severe PUD
what is cause of menetrier disease
excessive secretion of transofrming growth factor alpha
Tx mentrier disease in children
goes away on own usually
Sx menetrier disease in children
weight loss, diarrhea, peripheral edema
cause Z-E syndrome
gastrin secreting tumore: gastrinoma
Sx Z-E syndrome
chronic diarrhea, multiple peptic ulcers
what cell # is greatly increased in Z-E syndrome
parietal cells
Tx for Z-E syndrome
block acid production
find and remove the tumor
majority of gastric polyps are what
inflammatory and hyperplastic <1cm
fundic gland polyps are found in what population
F>M PPI related because of increased gastrin
gastric ademoa greater than 2 cm is assoc with what
carcinoma
polyp with corkscrew shaped foveolar glands
gastric hyperplastic polyp
3rd most common cause cancer death worldwide
stomach
stoamch carcinoma is associated with
H pylori
>90% originate from glandular epithelial cells of the stomach (adenocarcinoma)
population affected by gastric cancer
55 y.o M>F
aggressive
Describe intestinal type stomach carcinoma
M>F assoc with prior H pylor infection TLR4, APC/WNT pathyway, p53 gatric antrum/pylorus lesser curvature>greater
describe diffuse type (signet ring) stomach carcinoma
no decline increasing incidence M=F no association with H pylori or precursor lesion CDH1/E cadherin mutations, p53 dismal 5 yr survival occurs throughout stomach
what cancers involve mutation sin APC/WNT pathway
intestinal type gastric cancer and colon CA
what mutation is assoc with diffuse gastric carcinoma
mutation in tumor suppressor CDH1
also mutation in lobular CA of breast
stomach carcinoma is classified by
depth of invasion
macroscopic growth pattern
histologic subtype
what is important for prognosis of stomach carcinoma
depth of invasion and lymph node status
where is sister mary joseph nodule
irish node?
virchows node?
sister mary joseph is belly buton
virchow is neck/supraclavicular
irish is axillary node
what is linitis plastica
extreme form of flat or depressed advanced gastric carcinoma
signet ring cells
diffuse gastric carcinoma
what is name for mesenchymal tumores of stomach
gastro intestinal stromal tumor
most common site extra nodal lymphoma
stomach
2 types gastric lymphoma
indolent extra nodal marginal zone B cell lymphoma (MALToma, H pylori related)
diffuse large B cell lymphoma (high grade)
translocations assoc with gastric MALToma
and net effect?
t11;18 q21;q21 and t1;14p22;q23 and t14;18 q32;q21
all result in activation of NFkbeta that promotes B cell growth and survival
lymphoepithelial lesions with neoplastic lymphocytes in gastric glands
dx?
gastric MALT lymphoma
markers for gastric MALT B cell lymphoma
CD19 and 20+
monoclonal light chains
2nd most common gastric lymphoma
DLBCL
GIST mesenchymal tumors arise from what
interstitial cells of Cajal, pacemakers
most common abdominal mesenchymal tumor?
mutations?
GIST
tyrosine kinase c-kit CD117 mutations
some are PDGFRA mutations
Tx GIST
appearance histo?
imatinib-ckit
spindle cell feature
